| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,221 |
2,954 |
$72K |
| D1110 |
Prophylaxis - adult |
2,091 |
1,894 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,262 |
2,109 |
$35K |
| D1120 |
Prophylaxis - child |
1,370 |
1,272 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
338 |
194 |
$31K |
| D0274 |
Bitewings - four radiographic images |
996 |
880 |
$27K |
| D0330 |
Panoramic radiographic image |
322 |
288 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
79 |
52 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
257 |
238 |
$10K |
| D0272 |
Bitewings - two radiographic images |
402 |
371 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
73 |
50 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
332 |
300 |
$4K |
| D1206 |
Topical application of fluoride varnish |
243 |
198 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
113 |
89 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
12 |
$402.73 |